Accupril

[Jenny]

I am looking for new or up to date information on the use of Accupril (Quinapril or Accuretic) and preterm babies. The postnatal ward I work on as Lactation Consultant is using this drug postnatally and in 'Medication and Mothers Milk' it suggests this is a L4 risk for preterm babies. Is there any new information or any suggestions of how preterm.

[cpride]

Dear Jenny,

Quinapril is an angiotensin converting enzyme inhibitor (ACE) used as an antihypertensive. Once in the plasma compartment, quinapril is rapidly converted to quinaprilat, the active metabolite. In one study, levels of quinapril in milk were low and levels of the active metabolite were not found in milk. It is estimated that the relative infant dose (RID) of quinapril is 1.6% of maternal dose. Special care should be given when breastfeeding preterm infants while using this drug. In other infants, the risk associated with this medication while breastfeeding is lessened. Quinapril is considered L2 in term infants but L4 in preterm infants due to the risk of renal toxicity. All ACE inhibitors have the risk of renal toxicity with premature infants especially those less than 30 weeks gestation and use should be discouraged. For those greater than 30 weeks gestation, renal function should be monitored closely. Hope this information is helpful. You may call the InfantRisk Center for further information. We are open Monday through Friday, 8 to 5 CDT.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center